Advice on FIL, morphine and driving. Sorry - long.

[JesusInTheCabbageVan]

Posting on behalf of DH, who is very worried. Here's what he's written. Any advice, insights or similar experiences appreciated!

My father is 81 years old, lives by himself, and has limited mobility due to a leg ulcer. He has had the ulcer for 8 years or more, and it dominates his life. His days are a cycle of dressing changes, medication, and keeping himself occupied as best he can in his bungalow. He has become pretty frail and under-nourished, though I’m hoping the latter will be addressed with a new meals service he has found.

He has previously been a keen driver, and it’s actually pretty difficult to live where he does (in a tiny village in Devon) without his own transport. Following a fall which made him more unsteady on his feet, he hasn’t been driving for several months now. Even when he was driving, he had one serious accident (no serious injuries, fortunately) and several smaller prangs. He claims all of these accidents have been other drivers’ fault – I struggle to believe this but can’t prove otherwise.

He has been saying for some time that he’d like to get back to driving. He even claims that he has had someone assess his driving in a ‘test’ of some sort, but again I don’t really believe this (and no evidence has been forthcoming). I’ve suggested he sell his car and use the funds to pay for taxi trips when needed, but he’s not keen.

He is also displaying some issues with his short-term memory, which I’d previously assumed were a side-effect of the medication, but increasingly think they may be indicators of some sort of dementia.

In short, I don’t want him to drive again. I have little chance of ‘persuading’ him to give up, and I don’t want to go down the route of secretly informing DVLA unless I really have to. What I’d like is some advice on whether he should be driving at all, based on the medication he is taking.

Currently, he is taking slow release morphine twice a day – 30mg morning and evening. When he has significant pain, he tops this up with up to 30ml of liquid morphine, possibly more. (My sister is concerned that his GP isn’t following the recommendation that if morphine doesn’t stop the pain, it shouldn’t be prescribed. But this is a separate issue.)

My question is whether someone is likely to be able to drive safely on this kind of morphine dose – either on the regular slow release dose or the increased dose. I’m pretty sure he wouldn’t drive when feeling a lot of pain anyway, but I suspect that he shouldn’t be driving even on the smaller dose. The law allows for people prescribed morphine to drive (up to 80µg/L in the blood), but I don’t know in practice how my dad’s dosage translates to blood levels.

I’m aware that there are bigger issues here – whether he should be living alone, the possibility of dementia tests, whether this too impacts his ability to drive. But it struck me that the morphine question may be the quickest and easiest one to answer for now.

Many thanks for any help/advice you can offer

Age Uk has a good page of information:

www.ageuk.org.uk/information-advice/travel-hobbies/driving/worried-about-someones-driving/#

It can be difficult when it’s not something clear cut like a seizure that means you can’t drive. From what I can see on the DVLA site, as long as it’s prescribed and he’s not drowsy, that won’t stop him driving. Sounds like there’s lots of reasons to be concerned he’s not safe.

I met an elderly lady once who had an account with the local taxi company - her children paid for it as a gift and it meant she didn’t need to worry about having enough cash. Any change he’d be more agreeable to that?

Take unfortunately not... He's very reluctant to admit that anything is wrong, to the point that he tells blatant lies rather than admit he may have a problem. To give an example, he claims he's had a driving test recently and passed with flying colours, so much so that the examiner extended the test time because he was enjoying it so much. Yet he's unable to provide any details of who tested him, no documentary or email evidence etc. He's told lies about other things as well, not maliciously, but all geared toward showing how strong and independent he is.

A blunt chat about how he would cope if he killed someone imo.

April Tbh, that would be my favoured approach if all else fails. The issue is that he's convinced that he knows best (this has always been the case - he can't be seen to be wrong and has always been happy to make stuff up in order to 'win' a conversation). Previously it's been harmless, but not now. We think he is genuinely in denial.

Speak to his GP. he may well advise FiL not to drive, I drove whilst on morphine but on a far far lesser dose and always mentally assessed myself before getting in the car. Many times I have said 'Not today' and left it.

Failing that for his long term safety and that of other people I think you will have to approach DVLA.

www.gov.uk/government/news/drug-drive-legislation-am-i-fit-to-drive

Prescription meds, including morphine, have limits set:
the limits that have been set for these drugs exceed normal prescribed doses, meaning that the vast majority of people can drive as they normally would, so long as:

• they are taking their medicine in accordance with the advice of a healthcare professional and/or as printed in the accompanying leaflet, and
• their driving is not impaired

Speaking to the GP is a good idea, thanks cant

Just as an aside, having to top slow release morphine up with liquid morphine when additional "breakthrough" pain is bad is pretty standard and doesn't mean that the morphine isn't working, merely that his normal dose doesn't always cover his pain but not so frequently that his day to day dose has to be increased. GP prescribing guidelines allow for this and his GP will be aware. I take a similar amount of slow release morphine to your grandad and regularly have to top up with extra liquid morphine-this doesn't mean it's not working, in fact it's hugely improved my quality of life.

The dose of morphine is not the issue. Many people do safely drive on morphine (including considerably higher doses) as long as it is prescribed, the dose is stable and their driving is not impaired.

Your issue is whether his driving is impaired or not. Essentially this is your issue, regardless of the morphine.

As a first step I'd speak to his GP regarding your concerns about his memory and whether he is developing dementia, and whether he is fit to drive given his enthusiasm for starting to drive again. The extravagant stories also point to a form of dementia.

I would also tell your FIL he will need to inform his insurance company of his health conditions, and his medication including the morphine or he won't be insured.

I would also challenge him about whether he is fit to drive with his ulcer having not driven for so long eg do an emergency stop. Be prepared for him to have a story about only driving slowly on roads he knows - you can counter with elderly driver ARE sent to prison for dangerous driving, how would he feel if he killed someone? His leg ulcers would not stop him being sent to prison - there are v v disabled 90+ yr olds in there.

Finally do not feel bad about an anonymous online report to the DVLA. It is commonly done and easy enough to say it is someone else eg a nurse who heard him talking about getting back at the wheel.

Thanks Anna and unweaved, ah has been following this thread and found it very helpful. We're going to see FIL tomorrow, so he's going to try talking to him and his GP. If he has no luck with them, he's going to contact the DVLA.

*DH.

Please update if possible, op, I'm concerned to hear about your FIL's situation.

I had to do this with DF after he was left so frail that he could barely get to the toilet. I bullied his GP into telling him he was no longer safe to drive and made sure I was there while it happened. Sadly, I also had the extra leverage of having lost DM in a car accident (she was the passenger) and told him I didn't want a matching pair of parent deaths. He was furious.

I also had to help a friend stop her mother from driving, as dementia was setting in. We removed the car keys while she was in hospital and persuaded her to sign a letter allowing us to sell the car for her. She was most upset, because 'she only drove locally and very slowly'. We set up a taxi for her, but she refused to use it.

Your FIL will be very upset, but for his sake, and the sake of the innocent people he could hurt or kill, stop him driving now.

Unfortunately you're going to have to go through the route of informing the DVLA you are concerned about his driving. You can do this anonymously, I did for FIL, nobody will ever know it's you. They will arrange a real test if they think it's necessary.

Your GP shouldn't discuss anything with you about his health unless they have his explicit permission to do so, but you can register your concerns.

This stage of parenting can be a bit of a nightmare. You have my sympathy.

I was absolutely fine driving on slightly higher doses of morphine, but then I was 36 and driving an automatic to protect my broken hip.
I would be very concerned about FIL driving regardless of the morphine.

Sorry for the lack of updates, we've been with him on a visit for the past few days.

He's clearly very frail now and I can't envisage him driving at all in the near future. Some signs of possible dementia, but I suspect he's already figuring out how to mask it - avoiding conversations that involve recalling recent events, that kind of thing.

DH had a really useful conversation with FiL's GP (FIL claimed he'd send him recently and been given the all clear to drive - that turned out to be another lie). GP said if we reported to the DVLA, they'd just contact him, and all he'd be able to say was that it depends on the individual, and whether they assesssed themselves as fit to drive etc. He said that he'd arrange an appointment with FIL and speak to him about driving, and hopefully form a more up to date impression of his competency. So we'll see how it goes, I guess.

*seen, not send